Neuroradiology

, Volume 60, Issue 7, pp 669–685 | Cite as

Cerebral venous thrombosis: state of the art diagnosis and management

  • Adam A. Dmytriw
  • Jin Soo A. Song
  • Eugene Yu
  • Colin S. Poon
Review

Abstract

Purpose

This review article aims to discuss the pathophysiology, clinical presentation, and neuroimaging of cerebral venous thrombosis (CVT). Different approaches for diagnosis of CVT, including CT/CTV, MRI/MRV, and US will be discussed and the reader will become acquainted with imaging findings as well as limitations of each modality. Lastly, this exhibit will review the standard of care for CVT treatment and emerging endovascular options.

Methods

A literature search using PubMed and the MEDLINE subengine was completed using the terms “cerebral venous thrombosis,” “stroke,” and “imaging.” Studies reporting on the workup, imaging characteristics, clinical history, and management of patients with CVT were included.

Results

The presentation of CVT is often non-specific and requires a high index of clinical suspicion. Signs of CVT on NECT can be divided into indirect signs (edema, parenchymal hemorrhage, subarachnoid hemorrhage, and rarely subdural hematomas) and less commonly direct signs (visualization of dense thrombus within a vein or within the cerebral venous sinuses). Confirmation is performed with CTV, directly demonstrating the thrombus as a filling defect, or MRI/MRV, which also provides superior characterization of parenchymal abnormalities. General pitfalls and anatomic variants will also be discussed. Lastly, endovascular management options including thrombolysis and mechanical thrombectomy are discussed.

Conclusions

CVT is a relatively uncommon phenomenon and frequently overlooked at initial presentation. Familiarity with imaging features and diagnostic work-up of CVT will help in providing timely diagnosis and therapy which can significantly improve outcome and diminish the risk of acute and long-term complications, optimizing patient care.

Keywords

Venous stroke Venous thrombosis Neurovascular Algorithm Review 

Notes

Acknowledgements

The authors would like to thank Drs. Reza Forghani and Almudena Perez of the Jewish General Hospital, McGill University, for case and illustration contributions.

Compliance with ethical standards

Funding

No funding was received for this study.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

Informed consent

This article does not contain any studies with human participants or animals performed by any of the authors.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Adam A. Dmytriw
    • 1
  • Jin Soo A. Song
    • 1
  • Eugene Yu
    • 1
  • Colin S. Poon
    • 2
  1. 1.Department of Medical ImagingUniversity of TorontoTorontoCanada
  2. 2.Department of Diagnostic RadiologyYale University School of MedicineNew HavenUSA

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